Guest Editorial
Health Environments Research
Architecture for Health Is Not
Just for Healthcare Architects
The purpose of architecture has been variably
described as design to improve human life, to
create a more livable and sustainable built envi-
ronment, and to construct practical spaces for
human activities. Architecture can heighten our
everyday experience from the dull to the specta-
cular and can comfort, elevate, and delight people
through thoughtful creation of space, surface, and
detail. It can create order and inspiration out of
building materials that then provide order and
inspiration for human activities. Implicit in these
goals is the ability of design to influence the phys-
ical and mental health of the people who live,
work, and play in the environments created by
architects.
Architecture can heighten our everyday
experience from the dull to the
spectacular and can comfort, elevate, and
delight people through thoughtful creation
of space, surface, and detail.
Health, Safety, and Welfare
Architects have long recognized the importance
of health, safety, and welfare as part of their mis-
sion. According to the American Institute of
Architects (AIA), health aspects of architecture
are those that have beneficial or salutary effects
on occupants and users of buildings or sites and
address environmental concerns. Safety aspects
of architecture limit or prevent unintentional
injury or death of occupants and users of build-
ings or sites. Welfare aspects of architecture
engender demonstrable positive emotional
responses from, or enable equal access by, users
of buildings or sites (AIA, 2018b). While these
& Design Journal
2018, Vol. 11(2) 8-12
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DOI: 10.1177/1937586718772955
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goals are favorable to health, their implementa-
tion sometimes reflects a spirit of compliance
more than of aspiration or inspiration. Design that
is limited to preventing harm by meeting building
codes and standards forfeits the full range of
design possibilities that could enhance the health
and quality of life of a building’s occupants and
visitors.
Design that is limited to preventing harm
by meeting building codes and standards
forfeits the full range of design
possibilities that could enhance the health
and quality of life of a building’s
occupants and visitors.
Beyond Healthcare Facilities
Architects who design healthcare facilities have
long considered the impacts of design on health.
They recognize the value of evidence-based
design, which is the process of basing decisions
about the built environment on credible research
to achieve the best possible outcomes (Ulrich
et al., 2008). For example, lighting, carpeting, and
nursing floor layout in a hospital may be selected
based on evidence of reduced medical errors,
fewer hospital-associated infections, or improved
treatment outcomes. But healthcare architecture
is only a small part of the work that architects can
do in designing buildings and places to promote
health. Most architects who work on healthcare
projects have projects in other sectors as well.
Rather than only focusing on patient, visitor, and
staff health and well-being within specific health-
care projects, architects should address all proj-
ects through the lens of health. Additionally, each
Editorial
healthcare project should address not just the
individuals served by that healthcare organization
but the entire community affected by the build-
ing’s construction and ongoing presence.
Most architects who work on healthcare
projects have projects in other sectors as
well. Rather than only focusing on patient,
visitor, and staff health and well-being
within specific healthcare projects,
architects should address all projects
through the lens of health. Additionally,
each healthcare project should address
not just the individuals served by that
healthcare organization but the entire
community affected by the building’s
construction and ongoing presence.
Most people spend about 90% of their time
indoors (Klepeis et al., 2001), so all buildings
have a meaningful influence on our daily lives.
Similarly, our cities are growing at a rapid pace;
54% of the world’s population resides in cities
today and this is projected to increase to 66%
by 2050 (United Nations, Department of Eco-
nomic and Social Affairs, Population Division
2014). By our nature, we have evolved to need
greater connection to the outdoors and physical
movement than typical buildings or cities enable.
Approaching both building and urban design
through a health lens can provide meaningful
impacts for individual, population, and global
health.
For example, an architect can design an attrac-
tive stairway that invites use (while locating the
elevator so that those who cannot use the stairs
have equitable access to upper floors). Adding an
accessory dwelling unit to a residence may pro-
vide housing for an elderly parent and improve
the social connectedness within a family. Provid-
ing daylighting in a school or workplace offers
mental health and productivity benefits as well as
energy savings for lighting. Thoughtful acoustic
design reduces the stress from unwanted noise
that has been associated with health risk and cog-
nitive distraction. Creating a transit-oriented
development encourages its residents to walk and
use transit more and to drive less, with benefits
9
that include increased physical activity, improved
air quality, and avoided motor vehicle injuries. In
each of these cases, evidence supports healthy
design strategies.
Addressing Societal Challenges
So why should architects care about health
beyond what they are already doing? By focusing
on the health-promoting aspects of design, archi-
tects have the opportunity to contribute to solu-
tions to major societal challenges, to lead change,
to improve the quality of life for everyone, and to
grow the demand for their services.
There are at least 10 major societal trends for
which architects can contribute health-promoting
improvements: obesity, housing and social
inequities, an aging population, urbanization,
nature contact deficit, hazardous chemical expo-
sures, energy poverty, water shortages and
excesses, natural disasters, and climate change.
 Obesity rates have been increasing over
recent decades in the United States and else-
where, contributing to the risk of cardiovas-
cular disease, diabetes, cancer, and death.
Healthy design can help reduce obesity by
providing venues for increased physical
activity and improved access to healthy food.
 Poor quality housing can lead to asthma and
other respiratory diseases, pesticide expo-
sures from efforts to eradicate cockroaches
and other vermin, injury from falls and fires,
and lung cancer from radon, with dispropor-
tionate impacts on people with low income.
More generally, substandard housing is dis-
piriting and is associated with poor out-
comes ranging from decreased academic
performance to depression. Healthy archi-
tectural design can yield affordable health-
promoting housing with fresh air circulation
and safe and attractive interior and exterior
components.
 The elderly—the nation’s fastest growing
age stratum—may experience reduced
vision, hearing, mental acuity and mobility,
falls and other injuries, and social isolation,
among other afflictions. Healthy architectural
design that reduces the risk of injury and
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accommodates the daily needs of persons
with disabilities becomes increasingly
important in an aging society.
 The proportion of the population choosing
to live in urban areas is growing globally.
Poorly planned urbanization can threaten
health through noise, crowding, reduced air
quality, nature contact deficit, and other
pathways. Well-planned urbanization, on
the other hand, minimizes these problems
and provides a healthy human habitat in
which people can thrive, while advancing
sustainability goals.
 Contact with nature provides a range of
benefits, such as restoration and stress
reduction, but many people lack opportuni-
ties for even limited nature contact. Healthy
architectural design, drawing on biophilic
principles, with high indoor environmental
quality, daylight, access to views and exter-
ior environments, and integrating with land-
scape architecture and urban planning, can
provide routine nature contact, from small
to large spatial scales.
 Tens of thousands of chemicals are now in
commercial use and many of these are used in
buildings. Growing evidence suggests that
some chemicals threaten health by acting as
endocrine disrupters, neurotoxins, carcino-
gens, and in other ways. Design specifications
that avoid the use of hazardous chemicals in
buildings are a primary prevention strategy
that protects both health and the environment.
 High energy prices strain the household
budgets of those affected and leave less
income available for food, housing, trans-
portation, and healthcare needs. Healthy
architectural design can create energy-
efficient, comfortable, and location-
efficient buildings, allowing residents to
spend more of their resources on other
needs. Energy efficiency also has an acute
impact on air quality in areas that produce
energy via coal, where respiratory and
asthma incidences are proportionally higher
(Tzivian, 2011); reduced energy use pro-
vides long-term benefits for atmospheric
and global health.
Health Environments Research & Design Journal 11(2)
 Water shortages reduce food supply,
hygiene, and habitability; floods displace
homes and businesses. Healthy architectural
design can avoid vulnerable locations such
as floodplains, conserve water, reduce flood
risk, and accommodate excess water,
thereby reducing sequelae such as mold and
excess runoff that can pollute waterways.
 Natural disasters frequently cause injury,
death, and displacement, especially in vul-
nerable populations. Healthy architectural
design can create resilient places that protect
people and facilitate recovery from disasters.
 Health effects of climate change include
heat-related illness, vector-borne disease,
and extreme weather events. Healthy archi-
tectural design can provide co-benefits
related to housing, transportation, and energy
use to mitigate climate change impacts.
AIA Priority
The AIA recognizes health as one of its priorities
for advancing the field of architecture. In April
2014, the AIA, the AIA Foundation, and the
Association of Collegiate Schools of Architecture
convened a group of organizations and leaders
from the worlds of design, policy, and public
health to explore ways to make connections
between design and health explicit. From these
discussions emerged the following six evidence-
based approaches designers can use to promote
health and well-being (AIA, 2018a):
 Environmental quality: Preventing, mitigat-
ing, and reversing chemical and microbial
pollutants that harm public health.
 Natural systems: Utilizing natural forms,
diverse species, and existing ecosystems
that relieve stress, accelerate recuperation,
encourage healthy eating, and promote
physical and social activity.
 Physical activity: Encouraging exercise,
recreation, and other daily activities that
lower the risk of cardiovascular disease and
other health problems.
 Safety: Reducing accidental injury and
crime to remove impediments to physical
activity and alleviate anxiety and stress.
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 Sensory environments: Diversifying the
touch, smell, and acoustics of an environ-
ment to promote safety, improve physical,
mental, and emotional well-being and
enhance the quality of life.
 Social connectedness: Strengthening per-
sonal and professional relationships and
encouraging behaviors like civic participa-
tion to increase happiness and ensure com-
munities function more effectively.
Challenges to Advancing Design
and Health
There are several challenges to promoting health
in the context of design. Few architects learn about
the health implications of design in their initial
training or in continuing education courses. While
healthy design may incur initial costs, many of the
benefits of health-promoting design are long term
and may not be realized by building owners or
occupants in the early years of building use. There
are relatively few empirical metrics of the health
benefits of good design, unlike sustainable design
in which factors such as water and energy use can
be readily monitored and quantified.
Next Steps
In the ideal world, architects and their clients will
begin to consider the health-promoting aspects of
design as routine and desirable as they now con-
sider sustainable elements of design. Many fea-
tures of sustainable design offer co-benefits of
promoting health.
To reach that stage, architecture students and
health science students need to be taught about
the health impacts of design. This information
should also be incorporated into continuing edu-
cation courses for both design and health practi-
tioners. Architects should work more closely with
city planners and landscape architects, who often
have a broader view of design and its impacts on
the surrounding environment. The use of
evidence-based design for promoting health
should be expanded beyond healthcare architec-
ture. Metrics to better document the health bene-
fits of design need to be developed. With those
11
metrics, checklists and certification programs can
be used to document when a building design pro-
motes health. Architects should be evangelists,
teaching their clients about the health-promoting
potential of buildings and advocating such design
choices, thereby growing the market. By recogniz-
ing the importance of the impacts of design on
health, architects can further contribute to the qual-
ity of life of all people, today and into the future.
Andrew L. Dannenberg, MD, MPH,
Affiliate Professor, Department of Environmental
and Occupational Health Sciences,
School of Public Health
Department of Urban Design and Planning,
College of Built Environments
University of Washington
Heather Burpee, M Arch, EDAC
Research Associate Professor, Director of
Education & Outreach, Integrated Design Lab
Department of Architecture, College of Built
Environments, University of Washington
Acknowledgment
The authors thank Shannon Criss, Eve Edelstein,
Thomas Fisher, Howard Frumkin, Michael
Monti, and Matthew Welker for their helpful
comments.
References
American Institute of Architects. (2018a). AIA’s design
and health initiative. Retrieved from https://www
.aia.org/pages/3461-aias-design-health-initiative
American Institute of Architects. (2018b). Health,
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Ulrich, R. S., Zimring, C., Zhu, X., DuBose, J., Seo,
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